HomeMy Public PortalAbout10715 LORA ST_Electrical__ s,76A663 D89 SA -5, APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ��������
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER '
FOR APPLICANT TO ILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN -6-- � C A 7
R CEIVEO BY READY FOR DAT ISSUED
ADDRESS FIRST INSPECTIONf y
CITY TEL NO. Q 77Z //AZV3
COUNTY LICENSE NO. EXPIRES Q
ADDRESS 107 /
PERMIT FEES ,L
FEE LOCALITY
NUMBER EACH
LIGHT OUTLETS NEAREST
CROSS ST.
RECEPTACLES
WALL SWITCHES OWNER r
TOTAL OUTLETS Lip Be III
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS a5 ITY TEL. NO.
FIXTURES 5 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE 19 CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS. 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL
/PROPERTY DE RIBED ABOVE.
I/2 & LESS .a5 SIGNATURE OF
/�I
�( II
%p a .50 PERM ITTEE,
a 9 1.00 INSPECTION RECORD
5 15 1.50 /� /�
15 50 2.50 �� s�'i(r/ CJ/�o�//!//7 7�L �' Ago"
50 200 5.Do ez-
ao0 Boo 10.013
Boo 1000 15.00Q
OVER 1000 20.00
' �� Z
O
M.G. SET/FRER. CHANGER-HP
WELDERS,AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% DF oR1G.)
MOVED MOTORS (75% or ORIG.)
Misc.
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO.LAMPS
FDR EACH PERMITI DATE INSPECTOR'B NAME
WIRING $1.00 Q CONDUIT
FIXTURES $1.00 /O WIRING ti✓v� }ry,i !Jf -c�4
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE UTILITY CO.NOTIFIED
FINAL
'WORKERS'COMPENSATION DECLARATION 76663 10/81
h27�by affirm that I have a certificate of consent to self CE-8o6G APPLICATION FOR ELECTRICAL PERMIT
ln`aure, W.a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof(Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
Q 1 Certified co is hereby furnished. EACH NO. FEE ADDRESS
copy Y New Residential Bldgs. 8 Pools
❑ 1 &2-Family,S Ft. $ _ $ LOCALITY (/
Certified copy is filed with the county building inspec- Y� q• -
tion department. Multi-family Sq. Ft. 'NEAREST /f
Residential Swimming Pools CROSS ST. V
,'Date Applicant OWNER OR �f//
/ -
FIRM NAME ,v (
CERTIFICATE OF EXEMPTION FROM WORKERS' MAILOutlets: Rec Lighr Sw.#_ ADDR
ESSCOMPENSATION INSURANCE First 20 0 71
�
.(This section need not be-completed If the work involved by Total,No. Additional CITY (/V leTel. No.
the permit is for one hundred dollars($100)or less.) PLAN CHECK
I certify that in the performance of the work for which this APPLICANT
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional
� Total No. CITY Tel. No. '
Date Applicant Fixed Applian es Not Over 1 HP PERMITj�
NOTICE TO APPLICANT: If, after making. this Certificate of APPLICANT
Exemption, you should become subject to the Workers' Range_ Heater—D.W. —
Compensation provisions of the Labor Code,you must forth- Oven —Dryer —W.M.— ADDRESS /vr
with comply with such provisions or this permit shall be Top FAU —W.H. —
deemed revoked. Hood _Fan _Other— CITY L Tel. No.�Z,S0
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG.NUMBER ® 3 Class.
(commencing with Section 7000)of Division 3 of the Business .DISTRICT NO. �OCEED Y
and Pr9fessions Code,.and my license is in full force and effect. Power Apparatus&Large'Appliances 0.
Size&Type HP, KW, KVA, or KVAR•
License Number ' Lic, Class Size
Up to 1 Incl. d
29
E�Q Over 1 to 10 Inc[.. DATv VALIDATION
Contractor 's` rri- Date Z J Over 10 to 50 Incl.
FINA
❑ I am exempt under Sec. I Over 50 to 1'00 Inc. BY LU
B.&P.C. for this reason Over 100 �
Date: Services, Swbd., MCC&Panelboards
0 -200 Amp. Under 600 V
Signature.. 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V'
Exemption for Reg. Maint. Elect.
SINGLE FAMILY Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and ,
Professions Cocl'e): •
❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors 6 0 4.9 A
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_
7044, Business and Professions Code). / # 0 0 0 0 0 2
CONSTRUCTION LENDING AGENCY I o o24,75
I hereby affirm that there is a construction lending agency for j
the performance of the work for which this permit is issued PERMIT FEE• (Sub-Total) o e 0 G 4,7 5
(Sec. 3097, Civ. C.). _ � � i
PLAN CHECKING FEE 1 202-86
Lender's Name
' ,• PERMIT ISSUING FEE Q
Lender's Address +q
I certify that I have read this application and state that the TOTAL FEE
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize.representatives of this County to enter upon
the ab ve-menti ne r1 o erty for' specction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
1
Si ature.of Frerrnfiftee Date